Most healthcare insurance plans provide networks of “approved” or “in-network” healthcare service providers. Typically, in-network healthcare service providers for a given healthcare insurance plan are healthcare service providers who have agreed to provide healthcare services in accordance with the given healthcare insurance plan provider's rules, including limiting what they charge for healthcare services in accordance with the given healthcare insurance plan provider's guidelines. Similarly, most healthcare insurance plans include approved or “in-network” medications. Typically, the providers of these approved medications have also agreed to provide the medications in accordance with the given healthcare insurance plan provider's rules, again including limiting what they charge for a given medication in accordance with the given healthcare insurance plan provider's guidelines.
Typically, in order to receive the full benefit of their healthcare insurance plan, a healthcare consumer must utilize in-network healthcare service providers and/or medications. Consequently, when a given healthcare consumer that is covered by a given healthcare insurance plan utilizes in-network healthcare service providers and/or medications, there is typically significant “out-of-pocket” cost savings to the healthcare consumer.
As an illustrative example, under some healthcare insurance plans, when a given healthcare consumer that is covered by the healthcare insurance plan utilizes an in-network healthcare service provider, the healthcare insurance plan pays 80% of the costs and the maximum out-of-pocket cost to the healthcare consumer is capped at a predetermined amount. In contrast, under some healthcare insurance plans, when the given healthcare consumer that is covered by the healthcare insurance plan utilizes an “out-of-network” healthcare service provider, the healthcare insurance plan pays only 40% of the costs and there is no cap on the maximum out-of-pocket cost to the healthcare consumer.
In addition, under some healthcare insurance plans, when the given healthcare consumer that is covered by the healthcare insurance plan purchases/uses a medication that is approved by the healthcare insurance plan provider, the medication is paid for in full by the healthcare insurance plan, or in some cases the healthcare consumer must pay a small co-payment. On the other hand, under some healthcare insurance plans, when the given healthcare consumer that is covered by the healthcare insurance plan purchases/uses a medication that is not approved by the healthcare insurance plan provider, the entire cost of the medication is borne by the healthcare consumer as an out-of-pocket cost.
In light of the discussion above, it is apparent that, at least from a cost perspective, it is highly advantageous for a healthcare consumer to use in-network healthcare service providers and medications. In addition, as healthcare costs continue to rise, there will ever increasing pressure on healthcare consumers to be sure to utilize healthcare service providers and/or medications that are in-network healthcare service providers and/or medications. However, as the average age of the population of the United States continues to rise due, in part, to the aging of the “baby boomers”, there is increasing demand for healthcare services and medications. As a result, many healthcare service providers, and medication providers, do not feel they need to be part of a healthcare insurance plan network and are no longer willing to accept the limitations imposed on them by the healthcare insurance plan providers. For this reason, and for various other possible reasons, healthcare service providers often drop their in-network status with a given healthcare insurance plan and many medications are taken off a given healthcare insurance plan's list of approved medications.
As a result of the situation described above, many healthcare consumers who have historically used a given healthcare service provider and/or medication can find themselves forced to change healthcare service providers and/or medications to avoid paying significantly larger healthcare service and/or medication fees for now “out-of-network” providers and/or medications. For many healthcare consumers, the prospect of changing healthcare service providers and/or medications is disturbing enough, however, to make matters worse, it often happens that a given healthcare consumer only discovers that his or her healthcare service provider and/or medication is no longer in the healthcare consumer's insurance plan network at the time the healthcare consumer needs the service and/or medication, or in some cases, after the healthcare service is provided and the healthcare consumer receives an unexpected bill.
In addition, under circumstances when a given healthcare consumer only discovers that his or her healthcare service provider and/or medication is no longer in the healthcare consumer's insurance plan network at the time the healthcare consumer needs the service and/or medication, the healthcare consumer typically has little or no time to research potential in-network replacements for his or her now out-of-network healthcare service provider and/or medication.
As a result of the situation described above, many healthcare consumers are currently subjected to significant amounts of stress and/or uncertainty because they are given insufficient notice that their healthcare service providers and/or medications are no longer in the healthcare consumer's insurance plan network.